Office Hours: Retinols, Acne Treatments Losing Effectiveness & Exfoliation

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Hello GW readers! For those of you who are unfamiliar with my blog Green Derm, Office Hours posts are where I answer reader submitted questions. I thought it might be worthwhile to move it here in the spirit of involving a new audience in these conversations. So regular readers, welcome to our Office Hours’ new home. Without further ado…

I’ve read that retinols are very important as an anti-aging ingredient but I do not know what they actually do to make skin younger, any help?

Retinols are the gold standard when it comes to topical anti-aging solutions. Most dermatologists will put patients seeking anti-aging products on a system that includes a protective sunscreen and a good retinol. One of the reasons dermatologists recommend retinols so highly is because there is a lot of science to back up the anti-aging results.

The way retinols work is through increasing skin cell turnover thereby forcing new cell growth. This action has been proven to further prevent collagen breakdown which has a positive effect on decreasing wrinkles/fine lines. The cell turnover property benefits both mature skin that has slower turnover rates and acne prone skin that is more likely to experience congestion.

If you are looking for the most powerful retinol, I recommend a prescription strength product that is more concentrated than anything you can buy on the market. In the US, you must get a dermatologist to write a prescription and most insurance will cover the majority of the cost for persons under 25. If you’re over 25 or do not want to have to see a dermatologist, the topical retinoid Differin (which used to be available by prescription only but is now available over-the-counter) retails for under $15. (GW Ed Note: James Samuel lists some of his favorites here)

My acne product is not working as well as it used to, what is the problem?


Topical acne treatments primarily use one of the three main active ingredients: exfoliating acid (usually Salicylic Acid), Benzoyl Peroxide, or Retinol. While all three work in their own unique ways, their individual mechanism can be problematic for long term effectiveness in that none of them really address the root causes of acne.

Exfoliating Acids work to tackle congestion as acne can be caused by oils and dead skin cells clogging the pores. Thus when you first begin using acids and pores become unclogged, you will notice improvement. However daily use will only provide diminishing returns. You’re not getting loads of oils and dead skin cells stuck in your pores EVERY DAY. These acids work much better to tackle cumulative congestion. So if you keep getting breakouts and continue to respond to it by exfoliating skin that does not need to be exfoliated further, you’ll only upset the balance of your skin and weaken it which is counter productive in the long run.

Benzoyl Peroxide similarly unclogs pores but it primarily works by killing the main form of acne causing bacteria. It is the primary active ingredient in Proactiv. The problem with continued usage is that Benzoyl Peroxide is also an oxidizing agent and a pro-inflammatory.  Many people with difficult to manage acne already have an extremely responsive immune system and thus chronic inflammation is triggered very easily. This means the persistence of Benzoyl Peroxide could worsen skin’s inflammation. There is also research that has shown the oxidizing action while initially beneficial for killing acne bacteria, can also CAUSE sebum oxidation, creating a substance called “squalene peroxide” which is one of the most comedogenic substances our bodies produce. This means over time pores become more susceptible to blockage which gives more opportunity for acne to occur.

Retinols are good for acne in that they promote cell turnover and have been shown to minimize sebum production. However, skin does can develop a tolerance for retinols so you have to use more and more (in higher concentrations) just to maintain the results. Your skin can also only turnover so quickly so at some point the results are going to plateau. Increased concentration or use of retinols could also mean the potential for irritation increases as well.

The take-away is that all these actives address one cause of acne and do not fully target the root causes. They are simply short term or immediate responses for a deeper condition. Unfortunately the Western medical approach to acne does not recognize acne as a condition that should be managed through holistic means of diet and lifestyle. I consider the existing approaches to be heavy handed, addressing only symptoms in an overly aggressive approach and not providing actual solutions.

How often should I be exfoliating my skin?


There is no right or wrong answer here. Many people don’t make a concerted effort to exfoliate while others may be exfoliating too much. If you cleanse your skin in the morning and evening, chances are that you’re already providing a good amount of daily exfoliation. The need for an exfoliating step becomes more important if many products are used such as moisturizers, heavy sunscreen and especially make-up. If you’re working out, smoking or exposed to pollution, exfoliating will also be helpful. Many times, these substances make their way beneath what daily cleansing can reach and I recommend starting at a once-a-week exfoliation.

I prefer gentle chemical exfoliation such as Tata Harper’s Resurfacing Mask which works with beta hydroxy acids in a gentle manner or Boscia’s Exfoliating Peel Gel which is a more economic alternative (although TH ingredients are more aligned with organic/green standards).

Physical exfoliation should be reserved for skin that is not as “sensitive” and better for more “surface” issues such as dry patches and flaking. de Mamiel’s Brightening Cleanse & Exfoliate is a good option as a scrub that is kinder to skin. Farmacy New Day Gentle Exfoliating Grains is another good choice as you can add water to control the level of “roughness” you want and the formula is pretty gentle.

Acid toning is another option and is a subcategory of chemical exfoliation. It is often difficult to figure out how “strong” a toner is without trying. I recommend starting with a milder product such as First Aid Beauty’s Facial Radiance Pads which are pretty gentle (based on cucumber water) and use lactic acid & glycolic acid so they’re effective too.

If your skin is oily and acne prone, more exfoliation is okay. You’ll know that you’ve gone overboard when skin feels tight, dry, irritated or stripped.

Most guys can handle 2-3 times a week since our skin has thicker dermal density due to testosterone.


Any questions? Feel free to leave them in the comments section and I’ll answer them in the next Office Hours!


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