Despite being a common condition, acne is, by no means, a simple problem to solve. Besides medications and procedures, the lesions often require a combination of treatments to reduce recurrence and complications like scarring.
Skin cleansing is a cornerstone of acne treatment. But it’s hard to choose with the myriad of cleansing products in the market today.
What are the best soaps for acne? Is there a single skincare product that may be recommended to everyone with this skin concern? How do you know which skin cleanser is best for you? Learn about skin cleansing as part of acne treatment in this article.
What Does the Skin Barrier Consist Of?
The skin barrier, known medically as the stratum corneum, is the outermost skin layer. It’s structured like bricks and mortar, making it great for protection against environmental elements and body water loss.
The typical skin cells, called “keratinocytes,” are arranged side by side and on top of each other like layers of brick. The keratinocytes are enclosed by membranes made up of mostly “lipids,” a collective term for oils and fats, as well as some proteins and carbohydrates. Skin cells are held together by protein connectors (desmosomes) and a mortar-like, nearly impenetrable lipid mixture composed of ceramides, cholesterol, cholesterol byproducts, and free fatty acids.
The skin barrier prevents the entry of microbes and irritants into the deeper parts of the skin. Damage to this layer can lead to infection, irritation, or allergies. Moisture helps prevent breakage of this barrier, while dryness promotes damage, seen as skin cracking or scaling. Components that help minimize moisture loss in the skin include natural moisturizing factors (NMFs), the mortar-like lipid layer, and the enzymes that replenish the lipids in this layer.
Particles like dust, excess oil, and shedding dead skin cells are likely to get stuck in this lipid-rich layer. Friendly bacteria, or the skin microbiome, confer added protection by keeping harmful bacteria from growing on the skin’s surface.
What Happens When You Cleanse the Skin?
Water alone cannot remove debris and bacteria from the skin because it doesn’t mix well with lipids. You need substances called “surfactants” to improve water’s ability to mix with oily substances and clear them along with debris on the skin. Surfactants are classified as either soap or non-soap, and these types affect the skin differently.
What Is the Difference Between Soap and Non-Soap Surfactants?
Humanity has been using soap for cleansing for thousands of years. The ancient way to make soap is by mixing animal fat with a strongly alkaline (high pH) chemical like lye or potash, a process called “saponification.” Nowadays, plant and bacteria-derived fats have replaced animal fat to improve the sustainability of soap-making.
In simple terms, soaps—cleansers made by saponification—are mainly carbon-based and have a high pH, usually 8.5 – 11.0, which is far higher than the skin’s pH of 4.0 – 6.0. Some soap examples are sodium myristate and sodium laurate.
Typical soaps have a high pH and are strong surfactants, meaning they can take away skin impurities very effectively. However, this high pH can weaken the skin barrier by destroying proteins, stripping off essential lipids, and damaging skin cells, ultimately disrupting its orderly brick-and-mortar arrangement. A high pH can also kill off some of the skin’s friendly bacteria.
Skin barrier impairment promotes moisture loss and penetration of irritants and microbes, potentially leading to dryness, irritation, inflammation, and infection. These events can trigger acne breakouts.
On the other hand, non-soaps, also called “synthetic detergents” or “syndets,” have only been around since the 1940s. Non-soap cleansers are also made from sustainable fat sources but do not involve mixing with strong alkalis.
The processes that produce non-soap surfactants are complex. However, they yield sulfur-, ether-, or amino acid-containing fatty salts with a pH of 5.5 – 7.0, overlapping with skin pH. Examples include sodium lauroyl isethionate, sodium lauryl ether sulfate, and cocamidopropyl betaine.
Not all syndets are as effective in cleansing the skin as soaps. However, mixing several types in a single formulation produces cleansers with a combination of good qualities, such as improved cleansing and antimicrobial power, balanced pH, good rinsability, and gentleness to the skin. When used properly, non-soap cleansers do little to change skin proteins and lipids compared to soaps.
What Types of Surfactants Are Used in Skin Cleansers?
Skin cleansers are available in various forms, notably bars and alternatives with less solid consistency, like gels, creams, foams, and liquids. Cleansers are broadly classified based on solidity and composition.
Cleansing bars are commonly available in the following forms:
- Bar soap: Common soaps are examples of bar soap. All the fats in bar soaps are saponified, giving them a high pH.
- Superfatted soap: Only some of the fats in this kind of soap are saponified, so the pH is a little lower. This cleanser type is milder than ordinary soap. Unsaponified fats can moisturize the skin.
- Transparent soap: This type of cleanser has humectants (water attractants) like glycerol that give the product its clear appearance. Transparent soaps have a higher pH and more saponified fat than superfatted soap. Glycerol can act as a skin moisturizer.
- Combars: Combination bars have both soap and non-soap surfactants. These products have enhanced cleansing power but are milder on the skin than soap. The pH of combars is 9.0 to 9.5.
- Syndet bars: These cleansers contain only non-soap surfactants. They are pH-balanced and milder on the skin.
Less solid cleansers like liquid body washes and facial foams primarily contain non-soap surfactants. These cleansing products usually have lower pH values and are formulated to be sensitive skin-friendly.
What Other Active Ingredients Can Be Found in Anti-Acne Skin Cleansers?
Besides surfactants, cleansing product manufacturers may incorporate any of the following components that can help control face and body acne:
- Substances that curb the amounts of oil or sebum in the skin, such as niacinamide (nicotinamide), bakuchiol, and green tea extract
- Anti-inflammatory ingredients like aloe vera, hyaluronic acid, and shea butter
- Exfoliants that unclog pores, such as salicylic acid, glycolic acid, and mandelic acid
- Agents with antimicrobial properties like tea tree oil and benzoyl peroxide
- Antioxidants such as vitamins C and E
The right ingredient combination is one that improves acne and other skin issues, which differ from patient to patient.
How Should You Choose a Skin Cleanser for Acne-Prone Skin?
When looking for a skin cleanser, it’s best to seek the advice of a highly trained, board-certified dermatologist. These skin care specialists can accurately determine your skin type and identify other problems that may be solved by simply using the right cleanser or combination of skincare products. Your dermatologist can help you find out what your skin needs when you visit them for a skin examination.
The Baumann Skin Typing System
The Baumann system is one method of determining a person’s skin type. This system has the following categories:
- Oily vs. dry: This category differentiates skin types depending on how much oil the skin produces, which occurs on a spectrum from very oily to very dry. Normal skin falls between oily and dry on the Baumann spectrum. Combination skin has both oily and dry or normal regions, with the T-zone, comprised of the forehead, nose, and chin, often being the oiliest area.
- Sensitive vs. resistant: This category is based on the skin’s tendency to develop inflammation when exposed to environmental elements and skincare products. Sensitive skin may have underlying conditions like atopic dermatitis, rosacea, and proneness to severe acne.
- Pigmented vs. nonpigmented: This category distinguishes between skin types based on the tendency to develop hyperpigmentation after events like inflammation or excessive sun exposure, regardless of skin tone. Pigmented or P-type skin is prone to hyperpigmentation and is present in patients with melasma, brown spots, freckles, and post-procedure dyspigmentation.
- Wrinkled vs. tight (or unwrinkled): This category is based on the presence of skin aging signs, such as wrinkles and loss of elasticity, and their severity.
A complete discussion of the cleanser selection process is beyond the scope of this article, so we highly encourage you to talk to a board-certified dermatologist for guidance. However, some useful tips are explained below.
If you have oily skin, you may benefit from foaming cleansers, which effectively remove excess oil, and salicylic acid-containing cleansers, which minimize pore clogging. You may also try superfatted acne soap, which moisturizes the skin as it washes away impurities.
Nonfoaming cleansers are recommended if you have dry skin to avoid stripping away protective lipids from the skin’s surface. Facial scrubs are not recommended, as they can damage the skin barrier, worsen dryness, and cause irritation.
Most mild cleansers, such as syndets and superfatted soaps, may be used on the normal skin type. However, pH-balanced formulations may be required when humidity and temperatures are low. If you have combination skin, you may try mild face or body wash formulations primarily containing syndets.
If you have resistant skin, you may use most skincare products without experiencing side effects, even facial cleansers with higher exfoliant content. However, if you have sensitive skin, the best products to use are body or face wash formulations with anti-inflammatory ingredients and that do not alter skin and lipid composition significantly. You should also stay away from facial scrubs to avoid skin irritation.
P-type skin easily forms dark spots after treatment with highly concentrated chemical peels and powerful lasers, such as the CO2 laser. Nonpigmented or N-type skin does not. Patients with P-type skin may be prescribed skincare products containing arbutin, hydroquinone, or kojic acid, which lighten the skin and prevent hyperpigmentation after procedures.
If wrinkles are starting to show on your skin, you may be advised to use retinoid- and antioxidant-containing products in addition to a gentle acne body wash or facial cleanser. Your skin care specialist may recommend using a broad-spectrum sunscreen, preferably with SPF 30 at the minimum, when going outdoors, regardless of your skin type.
Best Skincare Ingredient Combinations for Acne
Acne is a symptom of skin inflammation. This condition can afflict anyone, not only people with oily skin. Choosing an acne soap is not as simple as it seems. That’s because your doctor needs to consider other potential skin or health problems that can impact the suitability and success of your treatment regimen.
Cleansers are only one product type your dermatologist may recommend for acne therapy. They may prescribe a face or body wash containing several active ingredients to complement your acne medications.
Alternatively, they may advise getting a simple cleanser together with other anti-acne products that have the right ingredients and potencies for your skin condition. Examples of such products include the following:
- Moisturizers: These products are applied frequently to dry skin. If you have oily, normal, or combination skin, your dermatologist may recommend using a moisturizer after cleansing.
- Toners: These products clean up skin impurities that remain after cleansing. You may be advised to use a regular toner if you have oily skin. If your skin tends to be dry, a moisturizing toner may suit you better.
- Oil-control products: Acne-prone skin usually contains abnormal sebum. If you have frequent breakouts, your dermatologist may recommend products with sebum controllers, like green tea extract, especially if you have oily skin.
- Antioxidants: Your skin care specialist may prescribe topical vitamin E if you have dry, sensitive skin.
- Camouflaging makeup: You may use these cosmetic products to conceal an acne lesion or scar. Different types have different ingredients, some of which may irritate sensitive skin, so you must ask your dermatologist before trying one.
- Sunscreen: UV rays can thicken the skin, clog the pores, and trigger pimple formation. Different sunscreens contain different active ingredients, but broad-spectrum types with a minimum of SPF 30 are generally recommended.
Combining active ingredients, whether by using standalone or multiple products, may be necessary to ensure complete skin protection during acne treatment. Again, it’s always best to consult with a board-certified dermatologist before using any anti-acne product.
How Do You Use Acne-Fighting Soaps Effectively?
Regardless of your skin type, a simple yet very helpful recommendation is to follow the label instructions for using a skincare product unless your doctor tells you otherwise. Additionally, you must strictly comply with your dermatologist-prescribed acne treatment regimen. These measures enhance the effectiveness and safety of your acne therapy.
Prolonged baths, especially at hot temperatures, must be avoided to prevent skin damage during cleansing. Acne soap must be rinsed thoroughly, as residues that stay for long periods can irritate the skin.
If you have dry skin, your dermatologist may recommend mild soap or non-soap cleansers or consider soap substitutes like cetyl alcohol. Frequent moisturizer use is a must.
Frequently Asked Questions
How Often Do Dermatologists Recommend Washing the Face?
The American Academy of Dermatology (AAD) advises limiting face-washing to only twice daily and after exposure to sweat. Perspiration can irritate the skin. Washing more frequently can strip away protective proteins and lipids and leave the skin vulnerable to damage.
Is Scrubbing Good for Acne-Prone Skin?
Exfoliation is good for skin health. It unclogs pores, prevents the accumulation of dead skin cells, and helps keep the skin optimally moisturized. However, the AAD discourages vigorous scrubbing in individuals with acne-prone skin. Scrubbing too aggressively can damage the skin barrier, potentially permitting the entry of irritants and acne-causing bacteria and leading to inflammation that can trigger a breakout.
However, patients with acne-prone skin may benefit from chemical exfoliation using products containing hydroxy acids, such as glycolic acid and lactic acid. These agents not only help prevent acne but also smooth out blackheads, whiteheads, acne scars, and wrinkles. Consult your dermatologist before trying these products.
Should You Skip Moisturizer If You Have Acne?
One of the contributors to acne formation is abnormal sebum production by the skin. Cleansing can wash off abnormal sebum but also risks taking away beneficial lipids, especially if overdone. Without these lipids, the skin can dry up and get irritated, which can also trigger a flare-up.
Moisturizers replenish lost moisture. That’s why your dermatologist may recommend using a moisturizer after cleansing, regardless if you have oily skin. Humectants, such as glycerin, aloe vera, and hyaluronic acid, are water-soluble moisturizers that attract water from the environment to the skin. Emollients like shea butter and ceramides are fatty ingredients that lock in moisture already on the skin’s surface.
Achieving Clear Skin with Dermatologist-Approved Soaps
Again, figuring out the best soap for acne is not an easy task. There’s no single product that can remedy this problem for everyone. Each skin type is different, and treatment success depends on various factors, including a product’s skin compatibility and suitability for managing associated problems.
However, you don’t have to pick a skin cleanser on your own. Working with a board-certified dermatologist ensures you are expertly guided on your skin care journey. Trusting a bona fide professional helps ensure your acne treatment is safe and effective.
Got Acne Woes? LA’s Top Dermatologists Are On It!
Skin cleansing is a key piece of your acne treatment regimen. That’s why choosing the right product is crucial. To find out which cleanser suits your needs best, a trusted professional’s recommendation is invaluable.
At BHSkin Dermatology, our board-certified dermatologists are some of the best acne experts in California. They have helped countless patients get rid of this skin issue and finally take control of it for good. Visit us at our Glendale or Encino clinic, or use our virtual portal for your first consultation.
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References:
- American Academy of Dermatology. (2024). 10 Skin Care Habits That Can Worsen Acne. Retrieved October 10, 2024, from https://www.aad.org/public/diseases/acne/skin-care/habits-stop
- American Academy of Dermatology. (2024). Face Washing 101. Retrieved October 10, 2024, from https://www.aad.org/public/everyday-care/skin-care-basics/care/face-washing-101
- American Academy of Dermatology. (2024). Sunscreen FAQs. Retrieved October 10, 2024, from https://www.aad.org/media/stats-sunscreen
- Araviiskaia, E., Lopez Estebaranz, J. L., & Pincelli, C. (2019). Dermocosmetics: Beneficial Adjuncts in the Treatment of Acne Vulgaris. Journal of Dermatological Treatment. 32(1), 3–10. https://www.tandfonline.com/doi/full/10.1080/09546634.2019.1628173
- Baumann, L., & Weisberg, E. (2009). Chapter 9: The Baumann Skin Typing System. Cosmetic Dermatology: Principles and Practice, 2nd ed. https://dermatology.mhmedical.com/content.aspx?bookid=2864§ionid=244974207
- Diaz, D., & Ditre, C. M. (2020). The Effect of Cleansers on the Skin Microbiome. Practical Dermatology. 4, 62-5. https://practicaldermatology.com/youngmd-connect/resident-resource-center/the-effect-of-cleansers-on-the-skin-microbiome/23269/
- Lafforgue, C., Try, C., Nicod, L., & Humbert, P. (2017) Chapter 18: Skin Care Products for Normal, Dry, and Greasy Skin. Textbook of Cosmetic Dermatology, 5th ed. https://dl.pezeshkamooz.com/pdf/dglibrary/book/medical/dermatology/cosmetic-dermatology.pdf
- Lin, T. K., Zhong, L., & Santiago, J. L. (2017). Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. International Journal of Molecular Sciences. 19(1), 70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796020/
- Mascarenhas-Melo, F., Ribeiro, M. M., Kahkesh, K. H., Parida, S., Pawar, K. D., Velsankar, K., Jha, N. K., Damiri, F., Costa, G., Veiga, F., & Paiva-Santos, A. C. (2024). Comprehensive Review of the Skin Use of Bakuchiol: Physicochemical Properties, Sources, Bioactivities, Nanotechnology Delivery Systems, Regulatory and Toxicological Concerns. Phytochemistry Reviews. 1-37. https://link.springer.com/article/10.1007/s11101-024-09926-y
- Mijaljica, D., Spada, F., & Harrison, I. P. (2022). Skin Cleansing without or with Compromise: Soaps and Syndets. Molecules. 27(6), 2010. https://www.mdpi.com/1420-3049/27/6/2010
- Mohiuddin, A. K. (2019). Skin Care Creams: Formulation and Use. Dermatology Clinics & Research. 5(1), 238-271. https://soapoilsandherbs.co.za/wp-content/uploads/2023/01/Skin_Care_Creams_Formulation_and_Use-1.pdf
- Mukhopadhyay, P. (2011). Cleansers and Their Role in Various Dermatological Disorders. Indian Journal of Dermatology. 56(1), 2–6. https://journals.lww.com/ijd/fulltext/2011/56010/cleansers_and_their_role_in_various_dermatological.2.aspx
- Subramanyan, K., & Ananth, K. P. (2009). Chapter 31: Cleansing Agents. Cosmetic Dermatology: Principles and Practice, 2nd ed. https://dermatology.mhmedical.com/content.aspx?bookid=2864§ionid=244975876
- Takharya, R., Dileep, J. E., Oudeacoumar, P., Kaliyaperumal, D., Sadasivam, I. P., & Dsouza, L. J. (2023). Comparison of Efficacy of 40% Mandelic Acid with 30% Salicylic Acid Peels in Mild-to-Moderate Acne Vulgaris: A Randomized Study. Turkish Journal of Dermatology. 17(2), 44-51. https://journals.lww.com/tjod/fulltext/2023/17020/comparison_of_efficacy_of_40__mandelic_acid_with.2.aspx
- Zhong, H., Li, X., Zhang, W., Shen, X., Lu, Y., & Li, H. (2021). Efficacy of a New Non-drug Acne Therapy: Aloe Vera Gel Combined with Ultrasound and Soft Mask for the Treatment of Mild to Severe Facial Acne. Frontiers in Medicine. 8, 662640. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175793/
Author: Don Mehrabi
Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online
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