Do I need to use a cleanser if I have acne?
First and foremost – acne is definitely and absolutely NOT caused by dirt on the skin. So cleansing to remove dirt to try to combat acne doesn’t make sense and can actually irritate the skin and make acne worse.
You might think this has a straightforward answer but like most things in skincare, it’s a lot more complicated than you might realise.
There are 4 general categories of skin cleansing agents: soaps, synthetic detergents, antibacterial cleansers and lipid-free lotion cleansers.
So let’s talk about cleansers. There are 4 general categories of skin cleansing agents: soaps, synthetic detergents, antibacterial cleansers and lipid-free lotion cleansers. True soap is very alkaline and is made via a chemical reaction that occurs when a fat and an alkali substance are combined. Though soaps work well to remove oil and dirt, it definitely damages the skin barrier because it disrupts the acid mantle therefore increasing skin sensitivity and irritation. It has also been suggested that the interaction of soaps with the proteins of the top layer of the skin causes temporary ‘swelling’ of these skin cells which may contribute to clogging of the follicles and formation of comedones.
Synthetic cleansers are designed to contain less than 10% soap and typically have a more neutral or even acidic pH than true soap, that is similar to the pH of normal skin. Antibacterial cleansers are usually a combination of a true soap or synthetic detergent with an added antibacterial agent. Though you might think using an antibacterial cleanser is a good idea for acne, in reality it does not penetrate the hair follicle enough to achieve a significant reduction in acne bacteria and, since they preferentially get rid of surface gram-positive commensal bacteria, overuse of these cleansers can lead to gram-negative bacteria overgrowth causing folliculitis (inflammation of the hair follicles on the face, which can often look similar to acne).
Lipid-free cleansers are the mildest of all skin cleansers on the market because they don’t contain soap, have a neutral pH and are designed to leave behind a thin moisturising film on the skin. They also do not contain dyes, fragrances or sensitising preservatives.
But is cleansing really that important? There is virtually no actual scientific evidence to support the idea that routinely washing your face twice a day even with a mild cleanser is beneficial to patients with acne. In fact, repeated exposure of the skin to water alone may disturb the epidermal barrier function, causing dehydration, irritation, changes to the skin pH and alteration of the normal skin flora.
However, cleansing in the morning does remove residue from retinoids used overnight which is possibly good because topical retinoids are ‘photoreactive’ and cleansing at night removes sunscreen and makeup that can interfere with the absorption of the night time prescription acne treatments you are using. So choose a very very mild cleanser and use it once or twice a day at most but cleansing alone is not the solution to clearing your acne.