Answer: Not really.
In most acne lesions (pimples, nodules, cysts, etc.), the site where the infection and inflammation occurs is not near the surface of the skin. Instead, it is near the base of the hair follicle (pores), which is an area that is not readily accessible from the surface. The inside of the follice is also a largely anaerobic environment (lower amounts of oxygen), and it has a different bacterial flora than the surface of the skin. Commercials for acne cleansers often have animations that show their product blasting out the debris from deep within the pore/follicle. In reality, this does not really happen because the follicle shaft is quite narrow relative to its depth, and because people with acne often have sticky “hyper-keratinized” plugs that are firmly lodged in the follicle.
The plugs that clog follicles and contribute to acne do not usually come from dirt or grime on the surface of the skin. Rather these pore-clogging plugs come from sebum, keratin and cell debris which is all produced deep within the follicle. However, foreign debris and bacteria that are on the surface of the skin can aggravate acne symptoms, particularly if you pop a pimple or damage the skin, allowing the surface debris/bacteria to enter the open wound. This can potentially cause increased inflammation and even a secondary infection, both of which can exacerbate existing acne symptoms.
Cleansers and Acne: The Positives
Twice daily use of non-medicated gentle facial cleansers was shown to decrease the number of open-comedos (blackheads) in a small study. However, non-medicated cleansers had no measurable effect on closed comedos and inflammatory acne (whiteheads, nodules, cysts). This is most likely due to the concept mentioned above, that the plug blocking the follicle is not easily accessible from the surface in closed comedo and inflammatory acne lesions. However, in the case of a blackhead (open-comedo), the plug is very near the surface of the skin, and is therefore more susceptible to to the action of cleansers. Another study by the same research group showed that a medicated cleanser that contained triclosan, salicylic acid and azelaic acid (antibacterial and keratolytic agents) was capable of decreasing the number of acne lesions when compared to a non-medicated control.
Triclosan, salicylic acid and benzoyl peroxide are common ingredients in over the counter (OTC) medications. The available research indicates that when cleansers are used in moderation they can be helpful in reducing minor acne symptoms for some patients.
It is important to note that most of the OTC medications have the same ingredients, and many acne sufferers use several of these products at the same time. This can easily lead to over-use of these products, resulting in dry and irritated skin. The positive effects of keratolytic agents and mild anti-bacterial compounds like triclosan are not cumulative and excessive use is likely to lead to more damage than benefit.
Cleansers and Acne: The Negatives
The primary concern associated with cleansers is overuse. When you have acne, you want to do something about it. That’s a natural response, but all too often that desire to act translates into an over-kill approach, like excessive face washing. Most of the studies on acne and face washing demonstrate that using cleansers more than twice a day causes more harm than benefit. In contrast to the misconception that dirty skin causes acne, over-washing the skin or washing the skin with abrasive or drying products is more likely to aggravate acne symptoms. Excessive washing or use of harsh products can damage and irritate the skin, leading to cracking, redness, inflammation, discomfort and ultimately worsen acne symptoms. The general rule of thumb is to use gentle cleanser in moderation to keep the skin clean. Washing the skin more than that is unlikely to provide much benefit and is more likely to make symptoms worse.
It is also important to limit your expectations for how helpful cleansers and face washing are going to be for your acne. Keep in mind that even the studies that show that cleansers help acne are only talking about moderate improvements for people with mild acne. The research does not suggest that cleansers help moderate to severe inflammatory acne. At no point do any of these research results indicate that cleansers can “cure” acne. At best, cleansers can only be expected to marginally improve acne symptoms.
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References and Sources
Kenet, et al. 2002. How to Wash Your Face: America’s Leading Dermatologist Reveals the Essential Secrets for Youthful, Radiant Skin
Winter. 2009. A Consumer’s Dictionary of Cosmetic Ingredients, 7th Edition: Complete Information About the Harmful and Desirable Ingredients Found in Cosmetics and Cosmeceuticals
Shalita, et al. 2011. Acne Vulgaris
Magin, et al. 2004. A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight.
Choi, et al. 2006. A Single-Blinded, Randomized, Controlled Clinical Trial Evaluating the Effect of Face Washing on Acne Vulgaris.
Choi, et al. 2010. A study of the efficacy of cleansers for acne vulgaris.