Archives of Clinical & Experimental Dermatology
Editorial | Vol 2 Iss 1
Citation: Narayanan V. Holistic Skin Care and Selection of Skin Care Products in Acne. Arc Clin Exp Dermatol. 2020;2(1):e101.
©2020 Yumed Text.
Holistic Skin Care and Selection of Skin Care Products in Acne
Consultant, Family Medicine and Holistic Health, Dr. Varsha’s Health Solutions, India
*Corresponding author: Narayanan V, Consultant, Family Medicine and Holistic Health, Dr. Varsha’s Health Solutions,
Mumbai, India; E-mail: email@example.com
Received: June 16, 2020; Accepted: June 18, 2020; Published: June 26, 2020
June is World Acne Awareness Month . Face washes are an integral part of acne treatment, while usage of cosmetics and
other skin-care products is also common in the acne age-group of teens and youth. An overview of considerations and
relevant parameters for skin-care products for people with acne or acne-prone skin, maybe beneficial as part of a holistic
approach to acne management.
As established, the pathophysiology of acne revolves around the blockage of the pores of the pilo-sebaceous units of the skin
due to hyper-keratinization and excess sebum production leading to comedo formation [2,3]. Subsequent inflammation and
infection cause the characteristic pimples or zits, more commonly seen on the face, thereby causing both cosmetic and
psychological concerns especially in the teens and youth. Though medicines, both topical and oral, are often prescribed for
acne, it is equally important to evaluate personal skin care. If one has a tendency for acne, some points kept in mind while
choosing skin care products like face washes, creams and cosmetics, can be beneficial .
Comedogenicity indicates the potential to lead to formation of comedones and development of acne. Finished products
containing high comedogenicity ingredients should be evaluated for their comedogenic potential. We have come a long way
from the introduction of the term ‘Acne Cosmetica’ by Kligman and Otto, and the use of the conventional ingredient-based
rabbit ear comedogenicity testing and grading model. Today non-invasive human follicular biopsy with cyanoacrylate glue
and the newer ‘in use-real world’ human testing of finished products, have increased the practical relevance and
interpretation of comedogenic potential of skin-care products [5-8].
Some acids and their salts especially in the Isopropyl form (Myristic, Stearic, Palmitic, Lauric acid), Algae extracts, and
foaming agent SLS (Sodium Lauryl Sulphate) have known high comedogenicity. Highly comedogenic oils include coconut,
wheat germ, cocoa, palm, and linseed oils, while others like almond, avocado, olive, peanut, jojoba and safflower oils are
relatively less comedogenic . Other Low comedogenic ingredients include Cetyl/ Cetearyl Alcohol, Polyethylene Glycol
(PEG), Glycerin, Simethicone, Sodium Hyaluronate, Hydroxy Propyl Methyl Cellulose (HPMC), Allantoin, Aloevera and
Talc. A combination of ingredients can change the overall comedogenicity of the finished product, hence the emphasis on
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human testing of the latter. Though Parabens, added as preservatives are not comedogenic, they have been seen to be
associated with long term skin damage in some studies, therefore now there is a shifting preference to ‘Paraben free’ skin
care products .
pH of our skin is naturally acidic between 5 to 5.9 that acts as a protective barrier to prevent infections, as well as acne. Most
soaps are alkaline as they contain ‘hydroxides’ with fatty acids. So, people with acne prone skin should avoid using soaps on
their faces and instead use liquid face washes or cleansers most of which maintain pH between 4.5 to 6 .
Moisturization and Oil Control are important attributes for skin care products for acne prone skin to help in maintaining
softness of the skin, reducing retinoid-induced dryness-irritation and also controlling oiliness at the same time. Substances
like Cetyl alcohol, Glycerin and Dimethicone can moisturize without greasiness while Zinc salts are known to control excess
sebum production .
Other Beneficial Substances are Exfoliative agents like Glycolic acid and Lactic acid (alpha hydroxy acids) that help in
removing dead skin cells, un-clogging pores and improving skin health and glow, along with Keratolytic agents like Salicylic
acid (beta Hydroxy acids) that help breakdown keratin plugging the skin pores . Astringents like Citrus fruit extracts,
Green Tea extracts (Catechin Tannins), Witch hazel and Rose water, help to cleanse, unclog and tighten pores, as well as
control oiliness . Nourishing and Soothing agents like Allantoin, Aloe Vera, Beta carotenes, Niacinamide (Vitamin B3),
Vitamin E and Vitamin C (Ascorbate) are non-comedogenic, non-irritant, and anti-inflammatory, therefore beneficial for
acne, and generally for the skin [9,12].
Holistic Skin Care in acne also requires a nutritious diet low on refined carbohydrates, sugar products and fat, and
increasing intake of whole grains, fruits, vegetables, and yogurt (curd) . Good hydration and increase in water intake,
regular fresh air, physical activity and exercise, adequate duration and quality of sleep, and stress management are other
aspects requiring emphasis.
1. Pigeon T. National Acne Awareness Month Focuses on New Findings, Resources. Editorial. Practical Dermatology.
2012. 45-6 p. https://practicaldermatology.com/articles/2012-may/national-acne-awareness-month-focuses-on-new-
2. Tanghetti EA. The Role of Inflammation in the Pathology of Acne. J Clin Aesthet Dermatol. 2013;6(9):27-35.
3. Dréno B. What Is New in the Pathophysiology of Acne, an Overview. J Eur Acad Dermatol Venereol.
4. Draelos ZD. The Effect of a Daily Facial Cleanser for Normal to Oily Skin on the Skin Barrier of Subjects with
Acne. Cutis. 2006;78(1 Suppl):34-40.
5. Calvarese M. Comedogenicity-A Complicated Conversation. November 2014 issue of Skin Inc. magazine.
6. Nguyen SH, Dang TP, Maibach HI. Comedogenicity in Rabbit: Some Cosmetic Ingredients/Vehicles. Cutan Ocul
7. Draelos ZD, DiNardo JC. A re-evaluation of the comedogenicity concept. J Am Acad Dermatol. 2006;54(3):507-12.
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8. Mills Jr OH, Berger RS. Assessing Comedogenicity: Current and Future Trends. Clinical Safety and Efficacy
Testing of Cosmetics 1990.
9. Comedogenic Rating of Skin Care Product ingredients: Skin Reference updated 2016.
10. Matweijczuk N, Galicka A, Brzoska MM. Review of the Safety of Application of Cosmetic Products Containing
Parabens. J Appl Toxicol. 2020;40(1):176-210.
11. Tarun J, Susan J, Suria J, et al. Evaluation of pH of Bathing Soaps and Shampoos for Skin and Hair Care. Indian J
12. Chularojanamontri L, Tuchinda P, Kulthanan K, et al. Moisturizers for Acne. What are their Constituents? J Clin
Aesthet Dermatol. 2014;7(5):36-44.
13. Kornhauser A, Coelho SG, Hearing VJ. Applications of hydroxy acids: classification, mechanisms, and
photoactivity. Clin Cosmet Investig Dermatol. 2010;3:135-42.
14. Thring TSA, Hili P, Naughton DP. Antioxidant and potential anti-inflammatory activity of extracts and formulations
of white tea, rose, and witch hazel on primary human dermal fibroblast cells. J Inflamm (Lond). 2011;8(1):27.
15. Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Postepy Dermatol