Why Your Acne Might Need Less, Not More

When treating acne harder starts working against the skin

When acne isn't improving, the natural response is usually to do more. You add another active, exfoliate a little more often, switch to a stronger cleanser or increase your retinoid because it feels logical that persistent acne needs stronger treatment. By the time many acne clients come to see us at Curated, their routine is often full of products that individually make complete sense for acne — but collectively, their skin isn't coping particularly well with any of them.

This is something I see all the time, and it's one of the reasons I don't believe treating acne is as simple as finding the strongest combination of acne ingredients someone can tolerate. There are absolutely evidence-based treatments and ingredients that can be incredibly useful in managing acne, but we still need to consider the condition of the skin we're asking to tolerate them.

Sometimes someone comes in expecting me to add something to their routine and I actually want to take three things away.

It can feel completely counterintuitive, particularly when the acne is the thing you desperately want to change, but sometimes doing less gives us the opportunity to get the skin into a much better position to eventually do more.

Acne-prone skin can still be compromised

There is a strange idea that oily or acne-prone skin must somehow be strong skin. Because there is oil present, we assume the skin can tolerate aggressive cleansing, frequent exfoliation and lots of active ingredients without needing the same hydration or barrier support we might associate with dry or sensitive skin.

In reality, we regularly see acne-prone skin that is oily and dehydrated. Acne alongside sensitivity. Acne alongside redness and inflammation. Skin that produces plenty of sebum but still feels tight after cleansing, stings when products are applied or has become increasingly reactive over time.

When I'm assessing someone with acne, I'm therefore not only looking at the breakouts. I want to know what the skin surrounding those breakouts is doing. How reactive is it? Is there visible inflammation? Does the skin feel comfortable? Is there significant dehydration? What does the barrier look like? What products are being used and how frequently?

Because we aren't treating acne in isolation. We're treating acne within a living piece of skin, and the health of that skin matters too.

How we end up doing too much

Most people aren't intentionally trying to compromise their skin. Usually, the opposite is true. They're trying incredibly hard to make it better.

You start with a cleanser for acne. Then someone recommends salicylic acid for congestion, so you add that. You hear retinoids are one of the best things you can use for acne, so you introduce one of those too. A breakout appears and you spot treat it. Your skin still feels congested, so perhaps you exfoliate more frequently. Then you see another product online that has amazing reviews and add that into the mix.

None of those decisions necessarily sounds unreasonable on its own. The problem is that skin experiences the whole routine, not the marketing rationale behind each individual product.

This is why I care so much about looking at everything someone is using together. A product can contain a great ingredient and still be unnecessary within a particular routine. Two products can both be appropriate individually and still create too much irritation when they're being layered or alternated too frequently.

The question isn't simply, “Is this a good acne ingredient?” It's, “Does this particular skin need this particular ingredient, in this formulation, at this point in its journey?”

More exfoliation doesn't necessarily mean less congestion

This is probably one of the easiest traps to fall into because exfoliation can make the skin feel instantly smoother. If you're experiencing congestion or texture, it makes sense that removing more surface cells feels like the solution.

Appropriate exfoliation can absolutely form part of an acne plan. The processes involved in acne include altered follicular keratinisation, so there is a legitimate reason that ingredients influencing cellular turnover are commonly used in acne management.

But that doesn't mean the answer is exfoliating as much as possible.

When someone is combining exfoliating cleansers, acid toners, active serums, retinoids and occasional peels, I start looking at the total amount of stimulation the skin is receiving rather than focusing on each product individually.

If the skin is becoming increasingly red, tight, flaky, sensitive or uncomfortable, continuing to increase exfoliation simply because congestion is still present may not be the direction I want to go.

Sometimes we need to get the skin comfortable again before we can properly assess what's underneath all that irritation.

The same applies to Vitamin A

I love Vitamin A and use it frequently within our skin plans. Retinoids are also among the most established topical treatments used in acne management, so this isn't an argument against using them. It's an argument for using them appropriately.

The strongest form or highest concentration isn't automatically the best starting point for every person. How Vitamin A is introduced, the formulation being used, how frequently it's applied, what else is being used alongside it and how well the individual skin tolerates it all matter.

If someone is using a product that theoretically has fantastic evidence behind it but their skin is constantly irritated and they're unable to use it consistently, we haven't necessarily created a particularly effective plan. Evidence informs what we use. Clinical reasoning helps us decide how and when to use it.

Sometimes we strengthen before we target

This is where our approach at Curated can look a little different from what someone expects when they book an acne consultation. If I look at your skin and see significant inflammation, dehydration, sensitivity or signs that it is struggling with the routine you're currently using, I may not immediately add another acne treatment.

We might simplify things first.

That could mean changing the cleanser, reducing the frequency of certain active ingredients, temporarily removing something that is creating unnecessary irritation, improving hydration or introducing more appropriate barrier support. Exactly what that looks like depends on the individual skin, because “barrier repair” shouldn't become another generic protocol either.

The purpose isn't to stop treating the acne forever. We're trying to create a better environment in which we can treat it. This is what we mean when we talk about strengthening and normalising before targeting and treating.

Sometimes that phase is relatively short. Sometimes, particularly when someone has spent a long time over-treating their skin, we need to be more patient. But I would rather take a little more time establishing good foundations than keep escalating treatment on skin that is clearly telling us it isn't coping.

I think of inflamed skin like a screaming toddler

This is probably one of the less scientific ways I explain skin in consultation, but it tends to make sense.

Imagine trying to reason with a toddler who is completely overwhelmed and screaming. You could stand there giving them more and more instructions, but they're probably not in a particularly good position to listen to any of them.

You calm them first.

I sometimes think about highly inflamed, reactive skin in a similar way. It's already telling us that something isn't right. If our response is to continually add stronger products, more exfoliation and more aggressive treatments, sometimes all we achieve is making it scream louder.

Obviously skin isn't literally a toddler, and this is simply an analogy rather than a description of skin biology. But it's a useful way of explaining why more intervention isn't always the same thing as better intervention.

Sometimes the smartest thing we can do is calm the noise enough to work out what the skin actually needs.

This matters with professional treatments too

The same thinking applies when someone comes in asking for skin needling, peels or another advanced treatment because they want to clear their acne faster.

I love advanced treatments when they're appropriate, but the word advanced doesn't automatically mean better. Treatments such as skin needling deliberately create a controlled stimulus and rely on biological repair processes within the skin. That means I care about the condition of the skin we're creating that stimulus within.

There are also treatments and clinical circumstances where active inflammatory acne changes what is appropriate altogether, which is why we don't choose modalities based purely on someone's end goal.

Sometimes a client will ask whether they can have a particular treatment and my answer is: Yes — but not yet. That doesn't mean we're delaying results for the sake of it. Preparing the skin is part of the treatment plan.

I would much rather introduce a treatment when I believe the skin is in an appropriate position to respond to it than perform something simply because it's what the client originally booked.

Less skincare doesn't mean no skincare

I also want to be careful with the idea of “doing less”, because skincare trends tend to swing between extremes. We go from complicated ten-step routines to suddenly being told we should use almost nothing at all. Neither approach makes sense for every skin.

Doing less doesn't mean abandoning evidence-based acne treatment, using only cleanser and moisturiser forever or becoming afraid of active ingredients. It means removing what isn't serving a purpose and creating enough space for the things that are useful to work.

Someone may still need Vitamin A. They may still need an ingredient that helps manage keratinisation. They may need prescription acne treatment. They may need professional intervention or medical support. The goal isn't minimalism for the sake of minimalism. The goal is appropriate treatment without unnecessary noise.

Your routine should make sense

One of my favourite things to do during a consultation is go through someone's current products and ask why each one is there. Not because I expect the client to know the science behind every ingredient, but because I should be able to explain what purpose each product is serving if I'm going to recommend they continue using it.

I don't want a routine made up of products that are there simply because somebody once said they're good for acne. I want the cleanser to have a reason. The active to have a reason. The moisturiser to have a reason. And if we introduce something else, I want there to be a reason for that too.

This is also why I don't necessarily replace someone's entire routine just because they've come to Curated. If you're already using something appropriate and your skin likes it, there may be absolutely no reason for us to change it.

The goal isn't to have a bathroom cabinet full of products from our clinic. The goal is to create a routine that makes sense for your skin.

If you've tried everything, you may not need another thing

When you've struggled with acne for a long time, doing less can feel like giving up. I completely understand that. If your skin is breaking out, you want to feel like you're actively doing something to stop it. But there is a difference between doing something and doing something useful.

Sometimes the next step in an acne journey is adding an evidence-based active or moving into more targeted treatment. Sometimes it is recognising that medical management would be appropriate. And sometimes the next step is taking a few things away, allowing inflammation and reactivity to settle, and rebuilding the foundations before we move forward again.

That's why I don't believe acne treatment should begin with a list of products everyone needs. It should begin with understanding the skin in front of us.

What is the acne doing? What is the surrounding skin doing? What have we already tried? What is helping? What might be making things harder? And what does this skin actually need right now?

Because sometimes acne needs more targeted treatment. And sometimes, before we can do more, the skin needs us to do a little less.

— Shae
Founder & Dermal Clinician
Curated Skin Aesthetics