How do I deal with acne on my body?

Body acneThe Question

My face is relatively clear, however I have acne on my body that hasn’t gone away. I wear a clean shirt to bed, yet I still have acne all over my back, chest and on my arms. How should I go about treating the acne on my body?

The Answer

Treating acne on the face and treating acne on the body requires the same ingredients and methods, however because the skin on the body is thicker, has less pores and is less sensitive you can use products with a higher percentage of active ingredients.

Two basic ingredients to look for are salicylic acid and benzoyl peroxide. This combination is usually too irritating for the face, but effective for the body.

Salicylic acid

Salicylic acid is commonly found in body washes and cleansers formulated for acne, it’s a liphophilic acid, meaning that it can dissolve in to sebum and help remove oily plugs and dead skin cells from the inner lining of pores. It also has a mild anti-inflammatory effect as well as a mild anti-bacterial effect. Salicylic acid is also found in pre-soaked alcohol based pads. It’s important that the pH of the product be lower than the pH of your skin to have an exfoliating effect, the greater the pH difference the more intense the exfoliation will be.

Common side-effects include redness, dryness and irritation – which usually resolves on its own.

Some may argue that because salicylic acid based washes are only on the skin for a brief period of time they can’t be effective in treating the skin, however a study showed that a 2% salicylic acid wash was better in reducing acne compared to an unmedicated wash, and was also superior to a 10% benzoyl peroxide wash.

For maximum effectiveness (but also increased risk of irritation, which is counter-productive) you can use medicated pads, or salicylic acid containing gels and liquids.

Benzoyl peroxide

Benzoyl peroxide is primarily an antibacterial, it works against acne by producing free radicals which kills anaerobic acne causing bacteria. However studies have shown that benzoyl peroxide also has a keratolytic or skin peeling effect, similar to that of salicylic acid. The downside to benzoyl peroxide is that it will bleach colored fabrics, which limits its daytime use (unless you always wear white t-shirts).

Benzoyl peroxide is most commonly available as a cream, gel or wash formulation – however cream and gels are most effective. Products generally contain between 2.5% to 10% benzoyl peroxide. Studies have shown that lower percentage benzoyl peroxide creams are just effective as the higher dosage ones, but people experience less side-effects like redness, peeling and irritation. Lower dosage benzoyl peroxides do take longer to have effect though.

Benzoyl peroxide treatment reduces levels of the antioxidant Vitamin E in the skin, consider supplementing with Vitamin E or using a product that contains the ingredient topically. However a study showed that with alcohol based benzoyl peroxide formulations, Vitamin E may actually increase free radical damage. This increase in free radical damage, however, may actually increase the effectiveness of benzoyl peroxide – so it’s a bit of a trade off.

A sample regime

I would recommend washing in the morning with a salicylic acid based cleanser, and then applying a benzoyl peroxide based cream in the evening (or mornings and evenings – if you’re conscious of the possibility of fabric bleaching).

Here are some recommendations for salicylic acid and benzoyl peroxide based products. It’s actually much easier to just go to a pharmacy or drug store and make a purchase there. I recommend a minimum of 2% salicylic acid, and 5% benzoyl peroxide. Look for products that do not contain fragrance or alcohol.

Because benzoyl peroxide is the same across brands, choose a product that provides the most bang for your buck. Good brands include Panoxyl, Benzagel and Solugel. Products from larger brands that are 1 oz. sized are generally overpriced.

I would recommend not buying salicylic acid products that are in a spray format, inhaling salicylic acid is a potent irritant, and as well the chemicals commonly used to dissolve salicylic acid – propylene glycol can be irritating.

Neutrogena Body Clear Body Wash, 2% Salicylic Acid

ProActive Solutions Clear Zone Body Lotion, 2% Salicylic Acid

Selsun Blue Naturals Dandruff Shampoo, 3% Salicylic Acid

Oxy Face Wash Maximum, 10% Benzoyl Peroxide

Topical, over the counter products are a good starting point, especially when used consistently. However some acne does require more aggressive treatment such as antibiotics (topical and oral), or in some cases isotretinoin. However those treatment methods require consultation with a dermatologist.

When to see a doctor

Most studies that have examined salicylic acid and benzoyl peroxide report improvements at the 8 to 12 week mark, so try to commit to that time period before re-evaluating your situation. Hopefully there is marked improvement, but if not, it may be time to consider booking an appointment and looking at prescription products.

What about diet and supplements?

Some studies have shown that a diet low in high glycemic foods, IGF containing foods like dairy can help resolve acne. Most of these studies were performed by one researcher Dr. Melkin. There are definitely links between diet and acne, and some studies have shown that chemicals found in dark chocolate can exacerbate acne.

Supplements can also help in treating acne. They also have the benefit of affecting your skin systematically. Consider supplements like zinc or pantothenic acid. Fish oil has also been shown to be anti-inflammatory which can benefit those dealing with acne.

Things to keep in mind…

Stop or reduce your frequency of application if you notice your skin starting to look raw, red or begin to crack and peel. Compromised skin is not only uncomfortable, but also has a reduced ability to fight off new infections which can lead to worsened acne. Let your skin return to it’s normal texture before continuing treatment.

Anything that speeds up the removal of dead skin will also increase your risk of sun damage. When dealing with body acne, clothing usually covers the areas treated which generally provides an SPF of 15 depending on the type of fabric and closeness of the weave. However do consider being extra cautious with exposed skin and use a higher SPF with broad spectrum UVA/UVB protection.

My skin is clear now…how do I keep it that way?

Keep on using the salicylic acid based cleanser, or switch to one if you’re using a pad. Salicylic acid not only will help keep your pores clear from oil and debris, it also exhibits a mild photo-protective effect (nowhere near sunscreen though, so don’t be overconfident with your sun exposure!). Because of it’s exfoliative effect, salicylic acid will also help fade hyperpigmentation left from acne break outs.

Reduce the use of benzoyl peroxide, as the free radical damage may have negative long-term effects (This hasn’t been thoroughly studied, but benzoyl peroxide has been shown to increase risk of skin tumor markers in mice.)

Consider using benzoyl peroxide once every other day, reducing to once every two days, eventually to once a week. You can also consider switching to using a benzoyl peroxide containing wash.

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