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Holistic Skin Care and Selection of Skin Care Products in Acne

  • Dr Varsha's Health Solutions


Editorial for World Acne Awareness Month June 2020 in Archives of Clinical and Experimental Dermatology.
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
Varsha Narayanan*
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:
Received: June 16, 2020; Accepted: June 18, 2020; Published: June 26, 2020
June is World Acne Awareness Month [1]. 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 [4].
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 [9]. 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 | June-2020
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 [10].
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 [11].
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 [12].
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 [13]. 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 [14]. 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) [15]. 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.
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.
2017;31(Suppl 5):8-12.
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
Toxicol. 2007;26(4):287-92.
7. Draelos ZD, DiNardo JC. A re-evaluation of the comedogenicity concept. J Am Acad Dermatol. 2006;54(3):507-12. | June-2020
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
Dermatol. 2014;59(5):442-4.
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
Alergol. 2016;33(2):81-6.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
The relationship between diet and acne is highly controversial. Several studies during the last decade have led dermatologists to reflect on a potential link between diet and acne. This article presents the latest findings on a potential impact that diet can have on pathogenesis of acne vulgaris. The association between diet and acne can no longer be dismissed. Compelling evidence shows that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne and the roles of omega-3 fatty acids, dietary fiber, antioxidants, vitamin A, zinc and iodine remain to be elucidated. The question of what the impact of diet is on the course of acne vulgaris still remains unclear.
Full-text available
Background: Normal healthy skin has potential of hydrogen (pH) range of 5.4-5.9 and a normal bacterial flora. Use of soap with high pH causes an increase in skin pH, which in turn causes an increase in dehydrative effect, irritability and alteration in bacterial flora. The majority of soaps and shampoos available in the market do not disclose their pH. Aims and Objectives: The aim of this study was to assess the pH of different brands of bathing soaps and shampoos available in the market. Materials and Methods: The samples of soaps and shampoos were collected from shops in the locality. The samples of different brands are coded before the analysis of the pH. Solution of each sample was made and pH was measured using pH meter. Results: Majority of the soaps have a pH within the range of 9-10. Majority of the shampoos have a pH within the range of 6-7. Conclusions: The soaps and shampoos commonly used by the population at large have a pH outside the range of normal skin and hair pH values. Therefore, it is hoped that before recommending soap to patient especially those who have sensitive and acne prone skin, due consideration is given to the pH factor and also that manufacturers will give a thought to pH of soaps and shampoos manufactured by them, so that their products will be more skin and hair friendly.
Full-text available
ABSTRACT: Numerous reports have identified therapeutic roles for plants and their extracts and constituents. The aim of this study was to assess the efficacies of three plant extracts for their potential antioxidant and anti-inflammatory activity in primary human skin fibroblasts. Aqueous extracts and formulations of white tea, witch hazel and rose were subjected to assays to measure anti-collagenase, anti-elastase, trolox equivalent and catalase activities. Skin fibroblast cells were employed to determine the effect of each extract/formulation on IL-8 release induced by the addition of hydrogen peroxide. Microscopic examination along with Neutral Red viability testing was employed to ascertain the effects of hydrogen peroxide directly on cell viability. Considerable anti-collagenase, anti-elastase, and antioxidant activities were measured for all extracts apart from the witch hazel distillate which showed no activity in the collagenase assay or in the trolox equivalence assay. All of the extracts and products tested elicited a significant decrease in the amount of IL-8 produced by fibroblast cells compared to the control (p < 0.05). None of the test samples exhibited catalase activity or had a significant effect on the spontaneous secretion of IL-8 in the control cells which was further corroborated with the microscopy results and the Neutral Red viability test. These data show that the extracts and products tested have a protective effect on fibroblast cells against hydrogen peroxide induced damage. This approach provides a potential method to evaluate the claims made for plant extracts and the products in which these extracts are found.
Full-text available
Hydroxy acids (HAs) represent a class of compounds which have been widely used in a number of cosmetic and therapeutic formulations in order to achieve a variety of beneficial effects for the skin. We review and discuss the most frequently used classes of these compounds, such as α-hydroxy acids, β-hydroxy acids, polyhydroxy acids, and bionic acids, and describe their applications as cosmetic and therapeutic agents. Special emphasis is devoted to the safety evaluation of these formulations, in particular on the effects of their prolonged use on sun-exposed skin. Furthermore, we summarize the very limited number of studies dealing with the modifications evoked by topical application of products containing HAs on photocarcinogenesis. In spite of the large number of reports on the cosmetic and clinical effects of HAs, their biological mechanism(s) of action still require more clarification. Some of these mechanisms are discussed in this article along with important findings on the effect of HAs on melanogenesis and on tanning. We also emphasize the important contribution of cosmetic vehicles in these types of studies. Thus, HAs play an important role in cosmetic formulations, as well as in many dermatologic applications, such as in treating photoaging, acne, ichthyosis, rosacea, pigmentation disorders, and psoriasis.
Cosmetics are a source of lifetime exposure to various substances including parabens, being the most popular synthetic preservatives. Because the use of cosmetics shows an increasing trend and some adverse health outcomes of parabens present in these products have been reported, the present review focused on the safety of dermal application of these compounds. Special attention has been paid to the absorption of parabens and their retention in the human body in the intact form, as well as to their toxicological characteristics. Particular emphasis has been placed on the estrogenic potential of parabens. Based on the available published data of the concentrations of parabens in various kinds of cosmetics, the average ranges of systemic exposure dose (SED) for methylparaben, ethylparaben, propylparaben, and butylparaben have been calculated. Safety evaluations [margin of safety (MoS)] for these compounds, based on their aggregate exposure, have also been performed. Moreover, evidence for the negative impact of methylparaben on skin cells has been provided, and the main factors that may intensify dermal absorption of parabens and their impact on the skin have been described. Summarizing, the use of single cosmetics containing parabens should not pose a hazard for human health; however, using excessive quantities of cosmetic preparations containing these compounds may lead to the development of unfavorable health outcomes. Due to the real risk of estrogenic effects, as a result of exposure to parabens in cosmetics, simultaneous use of many cosmetic products containing these preservatives should be avoided.
Acne is a chronic inflammatory disease of the pilosebaceous unit. Its pathophysiology includes hyperseborrhoea, abnormal follicular keratinization and Propionibacterium acnes proliferation in the pilosebaceous unit. Recent research has shed some new light on the involvement of the sebaceous gland, as well as on the pro-inflammatory activity of the cutaneous microbiome. During puberty, alteration of the sebaceous lipid profile, called dysseborrhoea, stress, irritation, cosmetics and potential dietary factors lead to inflammation and formation of different types of acne lesions. Dysbiosis, the process leading to a disturbed skin barrier and disequilibrium of the cutaneous microbiome, resulting in the proliferation of P. acnes strains, is another important process that triggers acne. P. acnes activates the innate immunity via the expression of protease activated receptors (PARs), tumour necrosis factor (TNF) α and toll-like receptors (TLRs), and the production of interferon (INF) γ, interleukins (IL-8, IL12, IL-1), TNF, and matrix metalloproteinases (MMPs) by keratinocytes, resulting in the hyperkeratinization of the pilosebaceous unit. Rebalancing the natural microbiome of the skin by restoring the natural skin barrier, limiting the proliferation of P. acnes on the skin by using topical antibacterials which do not cause resistance and regulating quantity and quality of sebum will be the main acne treatment challenges in the future. The aim of this article to provide an update on the involvement of the sebaceous gland, the innate immunity and the cutaneous microbiome, how all of these factors promote acne and to illustrate their links with current and future treatments.
Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. Different treatments offer different modes of action, but aim to target acne pathology. Topical therapies, such as benzoyl peroxide, retinoids, antibiotics with alcohol-based preparations, and salicylic acid, can cause skin irritation resulting in a lack of patient adherence. Some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical benzoyl peroxide or a retinoid is prescribed. Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne. Moisturizers contain three main properties, which are occlusive, humectant, and emollient effects. Currently, many moisturizers claim to be suitable for acne treatment. This article aims to provide a review of the active ingredients and properties of those moisturizers. Fifty-two moisturizers for acne were included for analysis. Most of the products (92%) have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. Anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol, were found respectively in 35, 10, and 8 percent of the moisturizer products containing anti-inflammatory properties. More than half of the products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatories that were commonly found in this study. Scientific data regarding some ingredients are discussed to provide a guide for physicians in selecting moisturizers for acne patients.
The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes the duct of the sebaceous follicle, causing an innate immune response and the progression from a so-called noninflammatory comedo to an inflammatory papule, pustule, or nodule. However, this viewpoint has come under increasing scrutiny over the last decade, as evidence has emerged supporting a role for inflammation at all stages of acne lesion development, perhaps subclinically even before comedo formation. The immunochemical pathways underlying the initiation and propagation of the inflammation in acne are complex and still being elucidated, but may involve Propionibacterium acnes as well as several inflammatory mediators and their target receptors, including cytokines, defensins, peptidases, sebum lipids, and neuropeptides. This review presents evidence to support the notion that acne is primarily an inflammatory disease, challenging the current nomenclature of noninflammatory versus inflammatory acne lesions and suggesting that the nomenclature is outdated and incorrect. The evidence in support of acne as an inflammatory disease also has clinical implications, in that anti-inflammatory drugs used to treat the disease can be expected to exert effects against all lesion stages, albeit via distinct mechanisms of anti-inflammation.
Comedogenicity is an important consideration in the development of topical medications, cosmetics, and skin care products. The concept of "acne cosmetica" was developed to link the use of certain ingredients to comedo formation. Animal models were originally used to determine the comedogenic potential of raw materials with the assumption that finished formulations containing these ingredients would also be comedogenic. Based on this assumption, dermatologists were presented with lists of substances to avoid in patients with the ability to develop comedones. We sought to use a modification of the Mills and Kligman human assay for assessing comedogenic potential of finished cosmetic products. Six individuals with prominent follicular orifices and the ability to form comedones on the upper aspect of the back were enrolled. Each person received patches to the upper aspect of the back saturated with 0.2 to 0.5 mL of the finished cosmetic study products 3 times weekly for 4 weeks. Cyanoacrylate biopsies were performed to determine the number of follicles and microcomedones per square inch. Only a finite number of finished cosmetic products could be analyzed. Finished products using comedogenic ingredients are not necessarily comedogenic.
Acne vulgaris is a common skin disorder that affects many people every year, especially the teenaged population. People with acne find the condition especially difficult to manage because of the disease's chronicity and variability in response to treatment. Acne is the result of pores clogged with shed skin cells combined with sebum in the hair follicle. Successful treatment of acne is important because acne has the potential to result in lasting physical and emotional scarring. For many years, physicians have agreed that although cleansing is not effective on its own, effective cleansing is an important part of any acne treatment regimen. However, patients have not been satisfied with the types of cleansers available. In addition to containing dyes and perfumes that can irritate and exacerbate acne, these cleansers often are too harsh and can result in excessive drying of the skin, which leads to overcompensation by the oil glands and ultimately to more oil on the surface of the skin. This study examined the use of a daily facial cleanser formulated for normal to oily skin in subjects with mild facial acne. The cleanser was studied for 2 weeks in the absence of additional treatments to eliminate the confounding effects of various treatments. Subjects were monitored for skin barrier function through transepidermal water loss (TEWL) and corneometry, sebum level, and lesion counts. The results of the study indicate that the facial cleanser is gentle and does not damage the skin barrier or result in sebum overcompensation; additionally, the cleanser is effective at deep-pore cleansing, which may help to manage some acne-associated symptoms.