How to treat acne & reactive skin

Acne is a chronic inflammatory skin condition involving:

• Clogged pores (from oil and dead skin buildup)
• Bacteria (C. acnes) that thrive in oily environments
• Inflammation that triggers red, swollen breakouts
• Hormonal or lifestyle factors that influence oil production

While mild acne can respond well to skincare, more advanced or persistent cases may need medical treatment.

Reactive skin isn’t a condition on its own—it’s a skin state. It means your skin becomes easily irritated, inflamed, or red in response to:

• Strong skincare actives (like retinoids or acids)
• Environmental triggers (sun, pollution, temperature shifts)
• Over-cleansing or over-exfoliation
• Stress or a disrupted skin barrier

Symptoms include:

• Stinging or burning when applying products
• Sudden redness or blotchiness
• Flaky or tight feeling skin
• Breakouts triggered by irritation—not oil

Deeper, Cyclical & Often Misunderstood

Hormonal acne is driven by fluctuations in androgen hormones—like testosterone—that increase oil production and inflammation. While it can begin in puberty, it's especially common in adult women during:

• Menstrual cycles
• Pregnancy and postpartum
• Perimenopause or menopause
• Hormonal birth control changes
• Conditions like PCOS or thyroid imbalance

How to Spot Hormonal Acne:

• Deep, painful cysts or nodules (under the skin)
• Concentrated around the jawline, chin, neck, or lower cheeks
• Flares up cyclically, often premenstrually
• Often paired with dry or sensitive skin
• May resist typical acne treatments

Best Approach:

• Topicals: azelaic acid, niacinamide, sulfur, encapsulated retinoids
• Barrier support: ceramides, fatty acids, gentle hydrating layers
• Medical options: spironolactone, hormonal birth control, prescription retinoids
• Lifestyle: stress management, blood sugar regulation, sleep support
• Avoid aggressive routines—gentle consistency works best here.

Classic Congestion with High Oil Output

Teen acne is caused by puberty-triggered hormonal shifts, which increase oil production and clog pores. It's the most common acne type—and often responds well to consistent skincare.

How to Spot Teen Acne:

• Shiny, oily skin (especially in the T-zone)
• Blackheads and whiteheads (comedones)
• Red or pus-filled bumps (papules and pustules)
• Forehead, nose, cheeks, and sometimes back/chest
• May come and go with hormonal waves or stress

Best Approach:

• Cleansers: gentle salicylic acid or benzoyl peroxide 2–3x/week
• Moisturizers: lightweight but hydrating (don’t skip!)
• SPF: critical to protect skin and prevent post-acne marks
• Avoid over-cleansing or harsh scrubs—this worsens oiliness and irritation
• See a derm if breakouts are severe or causing scarring

Often Mistaken for Acne

Despite its name, fungal acne isn’t true acne—it’s caused by yeast overgrowth in the hair follicles. It’s often mistaken for regular breakouts but doesn’t respond to acne treatments.

How to Spot Fungal Acne:

• Small, itchy, uniform bumps (no whiteheads)
• Common on the forehead, upper back, chest, or shoulders
• Doesn’t respond to traditional acne products
• Often triggered by humidity, sweat, antibiotics, or occlusive products
• May worsen with oily skincare or overuse of antibiotics

Best Approach:

• Topicals: sulfur, zinc pyrithione, ketoconazole cream or dandruff shampoo as a mask
• Lifestyle: keep sweat-prone areas clean and dry
• Avoid: thick, oily skincare or heavy SPF on the body
• If unsure, consult a derm to confirm and treat properly

Caused by Friction & Occlusion

Acne mechanica is caused by physical friction, heat, and trapped sweat, often due to masks, helmets, tight clothing, or even frequent face touching.

How to Spot Acne Mechanica:

• Breakouts appear in areas of contact: jawline, cheeks (from masks), shoulders, chest
• Often flares during hot weather, workouts, or with friction
• Red bumps, pustules, or clogged pores in clusters
• Not hormonal—driven by local irritation and occlusion

Best Approach:

• Cleansing: gentle cleanser after sweat exposure or exercise
• Barrier care: lightweight, breathable moisturizers to protect skin
• Avoidance: reduce friction (use mask pads, breathable fabrics)
• Treatment: salicylic acid or sulfur-based spot treatments as needed

A Mind–Skin Connection

Stress increases cortisol, a hormone that boosts oil production, triggers inflammation, and can delay skin healing—making it a hidden driver of breakouts.

How to Spot Stress Acne:

• Flare-ups during busy, emotional, or sleep-deprived periods
• Located on the cheeks, jawline, or forehead
• Can appear with a mix of whiteheads and inflammatory pimples
• May coexist with other stress symptoms: eczema, redness, dryness
• Often worse in those with pre-existing acne-prone skin

Best Approach:

• Routine support: simple, calming routine with hydrating and soothing ingredients
• Lifestyle focus: sleep, nervous system regulation (breathwork, adaptogens, gentle movement)
• Stress buffers: magnesium, B vitamins, and balancing skincare like niacinamide or centella
• Actives: keep gentle—azelaic acid, salicylic acid (in moderation), and barrier-repairing moisturizers
• Don’t underestimate the power of slowing down—skin reflects your internal state

Dry, Tight, Flaky

When your skin barrier is damaged—often from over-cleansing or too many actives—it can't hold onto moisture or protect against irritants.

Signs:

• Dry, tight, or rough texture
• Flaking or peeling
• Stinging with even basic products

Best Approach:

• Strip back to a minimal routine
• Use rich moisturizers with ceramides, squalane, and panthenol
• Avoid foaming cleansers, hot water, and exfoliants temporarily

Red, Blotchy, Easily Triggered

This type reacts to environmental shifts, temperature changes, or emotional stress. Often mistaken for rosacea.

Signs:

• Sudden flushing, blotchiness, or heat
• Sensitive to sun, wind, cold, or spicy foods
• May flare alongside stress or hormonal shifts

Best Approach:

• Include anti-inflammatory ingredients like centella asiatica, green tea, and allantoin
• Choose mineral sunscreens over chemical filters
• Keep routine consistent and calming

Reacts to Formulations

Some skin types become sensitized to specific ingredients, preservatives, or fragrance—not necessarily over-treated, but ingredient-reactive.

Signs:

• Burning, itching, or rash shortly after product use
• May tolerate some brands but not others
• Flare-ups with fragrance, essential oils, or alcohol

Best Approach:

• Look for “fragrance-free” and “hypoallergenic” labels
• Patch test everything
• Stick to short, simple ingredient lists and avoid essential oils

Temporary & Triggered by Actives

After procedures (like chemical peels, microneedling, or retinoid use), the skin may temporarily enter a reactive state.

Signs:

• Tightness, dryness, or mild flaking
• Redness after actives
• Feels “stripped” even with gentle products

Best Approach:

• Pause actives for 3–7 days (depending on severity)
• Focus on hydration, barrier support, and SPF
• Reintroduce actives slowly using the buffering method

Cleansing is essential for acne—but aggressive formulas can strip the barrier and increase sensitivity.

🟢 Choose:

• Gel or cream cleansers (sulfate-free)
• Low-level salicylic acid (0.5–1%) for acne-prone skin
• pH-balanced, fragrance-free options to avoid irritation

🟡 Avoid: foaming cleansers, drying alcohols, or scrubs.

When dealing with both acne and sensitivity, gentle actives are key. Start slow and prioritise non-irritating options:

• Azelaic Acid: Reduces redness, targets acne bacteria, and calms skin
• Niacinamide: Regulates oil, reduces inflammation, and supports the barrier
• Low-strength Retinoids (e.g., retinal or encapsulated retinol): Encourage cell turnover without harshness
• Salicylic Acid (BHA): Use sparingly to clear pores and reduce oil

💡 Start with 2–3x/week use and buffer with moisturiser to reduce irritation.

A healthy skin barrier is your best defense against both breakouts and sensitivity.

🟢 Add in:

• Ceramides: Restore the lipid layer
• Panthenol & Allantoin: Soothe and calm
• Glycerin & Squalane: Hydrate without clogging
• Centella Asiatica or Beta-glucan: Reduce inflammation naturally

When your barrier is healthy, actives work better—and your skin becomes less reactive.

🟡

• Over-washing or exfoliating
• Strong essential oils or fragrance
• High alcohol content in toners or treatments
• Applying too many actives at once
• Skipping SPF (UV stress worsens inflammation)

• Simplify your routine—remove exfoliants and actives temporarily
• Hydrate and repair with humectants (glycerin), barrier lipids (ceramides), and calming agents (panthenol, centella)
• Avoid triggers like hot water, foaming cleansers, or alcohol-based toners
• Use the sandwich method (moisturizer → active → moisturizer) to buffer treatments
• Patch test everything before introducing new products

1. Gentle, low-foam cleanser

Removes oil and sweat without disrupting the skin’s protective barrier—key for reactive skin prone to irritation or redness.

🟢 Look for sulfate-free, pH-balanced formulas with ingredients like panthenol, glycerin, or centella.

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2. Niacinamide or azelaic acid serum

• Niacinamide (2–5%): Regulates sebum, reduces inflammation, and supports skin barrier function.
• Azelaic acid (10–15%): Calms redness, clears pores, and fades post-acne marks without triggering irritation.

💡 Niacinamide is ideal for daily use; Azelaic acid may be best 3–5x/week or alternated.

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3. Lightweight moisturiser with ceramides

Replenishes lost lipids and helps repair the skin barrier, essential for calming reactivity and maintaining hydration.

Choose gel-cream textures if oily; creamier versions if dry or sensitised.

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4. Fragrance-free SPF 30–50

SPF is non-negotiable—even for reactive skin. Sun exposure worsens acne inflammation, delays healing, and deepens PIH (post-inflammatory hyperpigmentation).

💡 Look for mineral-based SPFs with zinc oxide if your skin is easily irritated.

1. Cream or gel cleanser

Use a gentle cleanser suited for evening to remove daily buildup without over-cleansing—especially important when using actives at night.

💡 If you're wearing makeup or sunscreen, see the double cleansing tip below

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2. Retinal or azelaic acid (2–3x/week)

• Retinaldehyde (Retinal): More tolerable than retinol, speeds up cell turnover and helps with clogged pores and texture
• Azelaic acid: Anti-inflammatory, antibacterial, and barrier-friendly—ideal for rosacea-prone or reactive skin

💡 Alternate or cycle based on tolerance to avoid overloading your skin.

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3. Hydrating serum

Humectants draw water into the skin while calming irritation—making them perfect for replenishing moisture lost from active ingredients.

🟢 Choose: Glycerin or panthenol

💡 They also create an ideal layering base to buffer stronger treatments like retinoids or azelaic acid.

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4. Barrier-repair night cream

Seals in hydration, reduces TEWL (transepidermal water loss), and encourages overnight repair.

🟢 Look for ceramides, cholesterol, and fatty acids—or multi-functional night creams designed for compromised skin.

Double cleansing (only if needed): 

Use an oil-based cleanser first to dissolve makeup or SPF, followed by a gentle second cleanse. This helps prevent congestion while protecting the barrier. Only double cleanse at night, and skip on bare-skin days.

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Buffer actives to reduce irritation:

Apply a thin layer of moisturiser before or after retinoids or azelaic acid to help minimise stinging and dryness. This is especially helpful when introducing new actives.

• Niacinamide or azelaic acid: 4–8 weeks for reduced breakouts and calmer skin
• Retinoids: 6–12 weeks for smoother texture and fewer blemishes
• Barrier repair routines: 1–2 weeks for less stinging and improved hydration
• SPF: Daily use prevents future sensitivity and post-acne marks

💡 Track skin progress weekly—and don’t layer too many changes at once. Less is often more when reactivity is involved.

• Get consistent sleep (skin heals overnight)
• Manage stress—it spikes cortisol and inflammation
• Avoid harsh physical exfoliants and popping pimples
• Use soft fabrics (e.g., for pillowcases and towels)
• Stay hydrated and eat skin-supportive nutrients (zinc, omega-3s, antioxidants)

“Acne means your skin is dirty.”

❌ False. Acne is complex—and often linked to hormones, inflammation, or bacteria.

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“You need to dry acne out to treat it.”

❌ Nope. Over-drying worsens both acne and sensitivity. Focus on balance.

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“Sensitive skin can’t handle any actives.”

❌ Not true. You just need the right actives, used slowly and strategically.