What to do when acne and wrinkles co-exist, Part 2!

Ok, so we’ve cleaned up the canvas. Now we need to get our glow on (like the effortlessy gorgeous Eva Green, left). Assuming regular use of a Vitamin A-derivative at night, and sunscreen during the day, most people with mild acne will be much better controlled after about 3 months.

Now, at this stage we need to buff and polish, evening out skin-tone and texture, encouraging the hasty exit of post-inflammatory hyperpigmentation. This is essentially an epidermal intervention-it should already be turning over nicely in response to the retinoid-but the great thing is, everything else you now apply will absorb more easily. So we want to improve pigmentation: uneven, dark patches absorb the light and stop our skin from ‘popping’.

There are any number of ways to improve this-my favourite approach is a multi-tasking one. I find that AHAs+pigment suppressors+retinoid=GLOW. The Obagi Nuderm system remains the gold-standard for me-combining prescription-strength hydroquinone, tretinoin, Vitamin C and glycolic acid; but you can equally use azelaic acid, arbutin or kojic acid to tackle pigmentation. Skinceuticals Pigment Regulator is a great alternative, as is La Roche Posay Pigment Control (in stores in January)-both are based on kojic acid and AHAs. Again, improvements occur over the course of weeks. At this stage I will suggest switching to a gentle cleanser (Cetaphil Gentle Cleanser or Avene Extremely Gentle Cleanser….they’re both….quite gentle!), using moisturiser when needed and sticking with the broad-spectrum sunscreen (minimum SPF30).

Once established on this, I might add in a home medical needling device, to significantly enhance product penetration and improve epidermal turnover. Its important to note that all of these steps might cause a bit of irritation in the first instance-so its important to go slow with any new intervention and support your skin’s barrier function with a non-comedogenic emollient along the way.

With a bit of diligence, your skin should now be posh and polished-looking. Next time-addressing deeper, dermal issues….

  1. Dear Dr. Sam,
    I apologize for the long post. I’m 28 years old, I have a combination, brake-out prone, fair skin and probably rosatia as I am pretty red on cheeks and nose. I used to have hormonal acne around the jaw line and on the lower part of my cheeks. I started following your advise months ago, and my skin is so much better. I really want to thank you for that!! I started using a gentle cleanser (beloved LRP), got my doctor to prescribe me finacea (I live in Italy) and I use both effeclar H and tolerian riche as moisturizer. I also use avene 30 cleanance sun screen on a daily basis. My skin is much better, no major hormonal breakouts anymore, just a few spots that pop up. But I still lack very much on glow, I still have some pigmentation issues and my skin texture is not smooth…I also have some kind of deep nose to mouth wrinkles, (where foundation always gets caught- I use Armani luminous silk even if I have an oily t-zone where makeup tends to slip off) and I also have a few wrinkles on the forehead and between my eyes. Until now I avoided retinoids because I am not sure if with my red/rosatia skin they would be the right thing to use.. But I would really like to improve texture glow and prevent aging. Would you suggest continuing with finacea or switching to something else? Until now I used finacea at night time and in the morning only moisturizer and sunscreen. What else could I do to improve things? I would love to come to see you in London but it doesn’t work out for me at the moment. Please let me know in case you start doing Skype consultations! Thank you so much for your time!

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