I love when a parent sits in the exam room and tells me to tell their tween or teen that they have acne because they don’t wash their face! Although it’s true that removing excess oil, keratin and sebum that builds up on the skin can help lessen and prevent acne, it’s definitely not the only cause. Hormones are the biggest culprit so I try not to blame patients habits on this common issue. After all, it’s so disappointing to not see much improvement from washing your face alone.
The reality is that I see the full age range from newborns to patients over the age of a 100. Its amazing to talk to patients that are 80 plus with beautiful skin who say they never really washed their faces except in the shower.
Often people forget that they are likely washing their faces in the shower. If you throw in another wash in the sink twice a day then you are likely getting three washes in. This may be a bit excessive. If your skin is on the dry side, reassess how many times you are truly washing your face and minimize it to what’s needed.
To use a toner or not: The key point to start with is that the word “toner” does not necessarily apply to one group of products or uses. What I have discovered is that the modern day use of the word “toner” in skin care truly refers to a leave-on product applied post-cleanse with a cotton ball or gauze pad. The “first generation” of toners, so-to-speak, played an astringent role. They were designed to pH balance the skin and degrease or strip away extra oil left on the skin after a routine cleanse. This is technically no longer needed as cleansers have evolved to address this concern without the need of an additional product. Modern day toners tend to have different ingredients to target different concerns. For example, several contain rosewater. This is an age old ingredient that has anti acne and anti aging properties. Chamomile is seen is some and thought to have calming qualities. And, some do have salicylic acid for acne.
Scrubbing or exfoliating the skin aggressively can actually worsen acne. I understand the need for a little exfoliation from an occasional gentle scrub. However, routinely aggressively scrubbing the skin can be counterproductive and just lead to more acne.
Probably the most important thing to consider is understanding soap and cleansers. You may not realize just how much work they do. Most cleansers are designed to do a few things. They are designed to clean, treat and leave some moisture behind. They differ from bar soap in that bar soaps are designed to clean as well but often have a higher pH which can alter the normal growth of bacteria and yeast on our skin. This can sometimes lead to a condition called seborrhea. This causes a greasy scaling around the eyebrows, eyelids, and nose. It’s a frustrating condition as people never know if they should exfoliate the scaling and risk feeling raw or moisturize it being left with a greasier feeling. It’s a good idea to look for products made for the face.
There’s a common tendency for people to look for “foaming” cleansers. There is this sense that if it doesn’t foam its not cleaning. Foaming can actually strip your skin of more natural oils. Just because a cleanser feels “slimy” doesn’t mean it isn’t working! Sometimes these ones will be far less irritating. Soap and water is perfectly ok to use as a cleanser but can alter the pH of the skin leading to a condition called seborrhea. If you prefer a bar soap, just check to see that it says facial bar soap to ensue that its likely formulated for facial skin. If you are looking for more “treatment” and not just clean, switch to a cleanser that touts added ingredients for various conditions such as acne or antiaging.
The most common misconception is how many times you need to wash your face a day. This can vary widely and ultimately our skin gets used to our habits. If you have really oily skin, washing your face twice a day may help. If your skin is dry or sensitive, washing twice daily can really strip your skin of natural oils and dry you out further. In these cases once daily at night may be best. If you are sweating quite a bit from a workout or play, washing your face afterwards can help remove excess bacteria and oil that builds up on the skin to reduce the tendency towards flares of acne.
Water temperature is often referenced when people talk about washing their face. Lukewarm water is ideal and gentle. Washing with hot water will not necessarily “open your pores”. It will make you flush and make your pores seem more prominent because of swelling in the skin. Will hot water open up your pores to empty them out? Probably not as much as you think. I worry that the hot water will only further strip the skin of natural oils. Similarly cold water to “shock” your pores closed seems like an unnecessary bit of discomfort to take on. Even if your pores seem temporarily a bit smaller from the cold water exposure, your body heat will warm them right back up to their original size:)
If you do wear makeup it’s a good idea to remove this before washing your face. Some heavier makeups and pigments do not always easily wash off with just soap and water. It helps to remove your makeup first with a makeup remover or Vaseline on a cotton pad, then cleanse.
After washing, applying a moisturizer is important to do. Some love the ‘tight’ feeling after washing their face! It just “feels clean”. However, this tight feeling is excess dryness that can start to peel or crack and feel sensitive afterwards. By applying a moisturizer you can effectively protect your skin from overdrying.
I’m not a fan of tools. The amount of bacteria that has been shown to build up in loofah sponges alone in studies is enough proof that these may not be a great idea- unless you are meticulous about constantly cleaning these in a bleach solution. I have had cases where patients have been so aggressive with facial scrubbing brushes and mechanical devices where they actually developed impetigo (an infection with staph bacteria) as a result. To get a simple wash, just use your hands. After all, once you have soap and water on them- they are clean! If you would like to use a gentle exfoliative then stick with ones that wash down the drain and are not reused. Sugar scrubs, apricot scrubs, etc. all work well for this purpose.